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European Journal of Heart Failure 2009 11(10):937-944; doi:10.1093/eurjhf/hfp118
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Gender differences in survival in patients with severe left ventricular dysfunction despite similar extent of myocardial scar measured on cardiac magnetic resonance

Deborah H. Kwon1, Carmel M. Halley1, Zoran B. Popovic1, Thomas P. Carrigan1, Victoria Zysek1, Randolph Setser2, Paul Schoenhagen1,2, Scott D. Flamm1,2, Randall C. Starling1 and Milind Y. Desai1,2,*

1 Department of Cardiovascular Medicine, Desk J1-5, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
2 Imaging Institute, Cleveland Clinic, Cleveland, OH, USA

* Corresponding author. Tel: +1 216 445 5250, Fax: +1 216 445 6155, Email: desaim2{at}ccf.org


  Abstract

Aims: We sought to determine the association between myocardial scarring, gender, and survival in patients with significant coronary artery disease (CAD) and severe systolic left ventricular (LV) dysfunction using delayed hyper-enhancement cardiac magnetic resonance imaging (DHE-CMR).

Methods and results: We studied 339 patients (24% women, mean age 65 ± 11 years) referred for assessment of myocardial viability by DHE-CMR. Scar was defined as myocardium with an intensity >2 SD above viable myocardium. Left ventricular scar (defined as a percentage of total LV myocardium), LV volumes, risk factors, cardiac transplantation (CTx), and all-cause mortality were recorded. There were 84 deaths and five CTx over 3.7 ± 1.6 years (median 4 years, interquartile range 2.6–4.9 years). Left ventricular ejection fraction (LVEF) in men was only slightly different from women (23% ± 9 vs. 25% ± 10, P = 0.05), whereas mean scar % was similar in both groups (32 ± 21 vs. 29 ± 20, P = 0.3). On univariable survival analysis, age [hazard ratio, HR, 1.03 (1.01–1.05), P = 0.002], female gender [HR 2.02 (1.31–3.12), P = 0.001], and scar % [HR 1.01 (1.003–1.02), P = 0.009] predicted outcomes; and also on multivariable analysis ({chi}2 32, P < 0.0001). Women with scar % greater than the median had more events, compared with men with or without a high scar burden (log-rank P < 0.001).

Conclusion: In patients with CAD and severely reduced LVEF, women have worse outcomes than men, irrespective of myocardial scar burden.

Key Words: Gender differences • Severe left ventricular dysfunction • Delayed hyper-enhancement CMR • Outcomes

Received May 18, 2009; Accepted June 16, 2009


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